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Pediatric inflammatory bowel disease: assessment with scintigraphy with 99mTc white blood cells
M Charron1, F J del Rosario, S A Kocoshis
1Department of Radiology, Children's Hospital of Pittsburgh, Pa., USA. charron@pop.pitt.edu
Insights
Technetium 99m white blood cell (WBC) scintigraphy accurately detects colonic inflammation in children. This noninvasive test shows high sensitivity and specificity for identifying inflammatory bowel disease (IBD).
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Nuclear Medicine
Background:
- Inflammatory bowel disease (IBD) diagnosis in children requires accurate assessment of colonic inflammation.
- Noninvasive diagnostic tools are crucial for evaluating pediatric gastrointestinal conditions.
Purpose of the Study:
- To determine the sensitivity and specificity of technetium 99m white blood cell (99mTc WBC) scintigraphy for detecting colonic inflammation.
- To evaluate the utility of 99mTc WBC scintigraphy in children with and without IBD.
Main Methods:
- 215 pediatric patients underwent 99mTc WBC scintigraphy, with uptake graded in 3,440 bowel segments.
- In 137 patients, 99mTc WBC scans were blindly interpreted and compared with colonoscopy and biopsy results.
- In 78 patients without recent biopsies, scan findings were compared with clinical assessments and long-term follow-up.
Main Results:
- 99mTc WBC scintigraphy demonstrated 90% sensitivity and 97% specificity for detecting colonic inflammation in children with IBD.
- Overall accuracy was 93%, with high positive (97%) and negative (93%) predictive values.
- Scan findings correlated well with clinical assessments and long-term follow-up in children without recent biopsies.
Conclusions:
- 99mTc WBC scintigraphy is a valuable noninvasive diagnostic test for children with suspected or known IBD.
- The imaging technique effectively determines the extent and distribution of colonic inflammation.
- This method aids in the diagnosis and management of pediatric inflammatory bowel disease.
Purpose:
To evaluate the sensitivity and specificity of scintigraphy with technetium 99m white blood cells (WBC) for detection of colonic inflammation in children with and children without inflammatory bowel disease (IBD).
Materials And Methods:
In 215 patients, uptake of 99mTc WBC in 3,440 bowel segments was graded. In 137 of the 215 patients, the 99mTc WBC scans were interpreted blindly and findings compared with results at colonoscopy and endoscopic biopsy. Planar, single photon emission computed tomographic, and maximum-activity-projection images were reviewed together. In 78 children without recent endoscopic biopsy results, 99mTc WBC scan findings were compared with laboratory values, the gastroenterologist's initial clinical assessment, and findings at long-term clinical follow-up.
Results:
In 128 of 137 children with recent biopsies, findings at histologic examination and on 99mTc WBC scans were correlated. There were seven false-negative and two false-positive studies. Sensitivity was 90%, specificity 97%, positive predictive value 97%, negative predictive value 93%, prevalence of disease 53%, and overall accuracy 93%. In 75 of 78 (96%) children without recent biopsies, 99mTc WBC scan findings were consistent with the laboratory values, gastroenterologist's clinical assessment, and long-term clinical follow-up findings.
Conclusion:
Scintigraphy with 99mTc WBC is a useful noninvasive diagnostic test to determine the extent and distribution of inflammation in children with IBD.